Abstract
Scalp nerve block with ropivacaine has been shown to provide perioperative analgesia. However, the best concentration of ropivacaine is still unknown for optimal analgesic effects. We performed a prospective study to evaluate the effects of scalp nerve block with varied concentration of ropivacaine on postoperative pain and intraoperative hemodynamic variables in patients undergoing craniotomy under general anesthesia. Eighty-five patients were randomly assigned to receive scalp block with either 0.2% ropivacaine, 0.33% ropivacaine, 0.5% ropivacaine, or normal saline. Intraoperative hemodynamics and post-operative pain scores at 2, 4, 6, 24 hours postoperatively were recorded. We found that scalp blockage with 0.2% and 0.33% ropivacaine provided adequate postoperative pain relief up to 2 h, while administration of 0.5% ropivacaine had a longer duration of action (up to 4 hour after craniotomy). Scalp nerve block with varied concentration of ropivacaine blunted the increase of mean arterial pressure in response to noxious stimuli during incision, drilling, and sawing skull bone. 0.2% and 0.5% ropivacaine decreased heart rate response to incision and drilling. We concluded that scalp block using 0.5% ropivacaine obtain preferable postoperative analgesia compared to lower concentrations. And scalp block with ropivacaine also reduced hemodynamic fluctuations in craniotomy operations.
Highlights
Ropivacaine is the drug of choice for administration of a local nerve block due to its longer duration of action compared with lidocaine and less cardiac and central nervous system toxicity than bupivacaine[10,11]
Three patients were excluded before completing the protocol due to surgical complication: one patient appeared with delayed extubation, while two cases presented with postoperative aphasia
The results of our study showed that SNB with 0.2%, 0.33%, 0.5% ropivacaine relieved postoperative pain for up to 2 hours after elective craniotomy under general anesthesia
Summary
Ropivacaine is the drug of choice for administration of a local nerve block due to its longer duration of action compared with lidocaine and less cardiac and central nervous system toxicity than bupivacaine[10,11]. Many researches pointed out SNB was effective and convenient, plasma concentration of local anesthetics increased rapidly after injection, unlike other neural blockades[12,13,14,15]. Zero patients had any signs of local anesthetic toxicity, a few patients reached excessive peak levels of ropivacaine, which have been previously reported to potentially develop into CNS toxicity symptoms in healthy volunteers[10]. Archer DP et al.[16] reported seven patients with signs compatible with local anesthetic toxicity shortly after local agent injection during craniotomy. This study aimed to evaluate the effect of SNB using different concentrations of ropivacaine (0.2%, 0.33% and 0.5%) on postoperative pain and hemodynamic responses in patients undergoing craniotomy under general anesthesia
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call